Differential Diagnosis for Severe Pain during Sexual Intercourse
- Single most likely diagnosis
- Endometriosis: This condition is characterized by the presence of endometrial tissue outside the uterus, leading to chronic pelvic pain, dysmenorrhea (painful menses), and dyspareunia (painful intercourse). The patient's symptoms of severe pain during deep penetration, painful menses, and the normal speculum examination support this diagnosis.
- Other Likely diagnoses
- Vaginismus: A condition where there is involuntary contraction of the vaginal muscles, making penetration painful or impossible. The patient's avoidance of sexual intimacy due to pain could be related to vaginismus.
- Pelvic Inflammatory Disease (PID): Although the patient has no chronic medical conditions, PID can cause chronic pelvic pain and dyspareunia. However, the absence of other symptoms like abnormal vaginal discharge or fever makes this less likely.
- Vulvodynia: A condition characterized by chronic pain in the vulva, which can cause dyspareunia. The patient's severe pain during intercourse could be related to vulvodynia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ovarian Cancer: Although rare in young women, ovarian cancer can cause pelvic pain and dyspareunia. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Ectopic Pregnancy: Although the patient is using condoms, there is still a small chance of pregnancy. An ectopic pregnancy can cause severe pelvic pain and dyspareunia, and it is a medical emergency.
- Rare diagnoses
- Adenomyosis: A condition where endometrial tissue grows into the uterine wall, causing dysmenorrhea and dyspareunia. Although less common than endometriosis, it could be a possible diagnosis.
- Interstitial Cystitis: A condition that causes chronic pain in the bladder and pelvis, which can be exacerbated by intercourse. This diagnosis is less likely but should be considered if other diagnoses are ruled out.